If you are injured at work, in many cases you have the right to be treated by your own physician, not the hospital’s Workers’ Compensation doctors. However, you must take action before you are injured. To preserve your right to be treated by your own physician, you must now have an agreement signed by your physician, as well notifying the hospital in writing before an injury occurs.  

In order to be treated by your choice of physician if you are injured on the job, fill out the form linked below. Make two copies and have your doctor or their authorized representative sign both. Give one copy to the hospital’s Human Resources Department and keep a copy for your own records.  

Predesignation of Personal Physician